Don’t let out of pocket expenses run you dry. We specialize in supplement and advantage plans.
Medicare Supplement Insurance, or Medigap, protects people who buy traditional Medicare against many of the additional costs a patient might pay. In return, Medigap charges a premium in addition to what the person already pays for Medicare Parts A (many people get this free), B, and D.
Just to make life truly confusing, the various options offered by Medigap are also sorted by letter: Plans A, B, C, D, F, G, K, L, M, and N. Medicare standardizes what these plans can include. The cost for these plans can vary widely and pairing you with the right Medicare Supplement plan is our number one priority at Point One Insurance.
Joseph Graves, insurance agent and founder of I Hate Buying Insurance, says many people enroll in Plan F—the most expensive choice—because it covers nearly all the gaps. A person with Plan F coverage will have few or no out-of-pocket expenses. However, after 2019, plan F will no longer be available to new Medicare recipients.
A Medicare Advantage Health Plan (Medicare Part C) may provide more help at a lower cost than traditional Medicare plus Medigap. Instead of paying for Parts A, B, and D, a person would enroll in a plan, which in many cases, covers everything provided by Parts A, B, and D and may offer additional services. In most cases, the beneficiary pays the Medicare Advantage premium along with the Part B premium.
Medicare Advantage Health Plans are similar to private health insurance plans. With most, services such as office visits, lab work, surgery, and many others are covered after a small co-pay. Depending on what’s available regionally, plans could offer a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO) network plan and place a yearly limit on total out-of-pocket expenses.
Also, like private plans, each has different benefits and rules. Most provide prescription drug coverage. Some may require a referral to see a specialist while others won’t. Others may pay some portion of out-of-network care, while others will only cover doctors and facilities that are in the HMO or PPO network.
What’s Really The Difference?
Cost: Medigap coverage usually has a higher monthly premium, but could result in lower out-of-pocket expenses than some Medicare Advantage plans. Medicare Advantage plans, on the other hand, generally cost less and cover more services, which can be the better option for your budget.
Choice: Medicare Advantage plans generally limit you to the doctors and facilities within the HMO or PPO, and may or may not cover any out-of-network care. Traditional Medicare and Medigap policies cover you if you go to any doctor or facility that accepts Medicare. If you require particular specialists or hospitals, check whether they are covered by the plan you select.
Lifestyle: Medicare Advantage plans often only operate within a certain region. If you’re a snowbird living in more than one state throughout the year, traditional Medicare plus Medigap is probably a better choice than an Advantage plan. This may also be true if you travel frequently because, while some Medigap plans provide coverage when traveling outside of the United States and cover you in all 50 states, Advantage plans generally do not.
Figuring out the Medicare plan that’s most appropriate for your needs is probably not a do-it-yourself activity. At Point 1 Insurance we work directly with multiple reputable insurance companies along with our clients to cater to each individual’s Medicare needs.
If you are interested in learning more about your Medicare options and discussing plans that best suit your needs we would love to hear from you.